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Public Health Is Purchasable. Within Natural Limitations Any Community Can Determine 

Its Own Death Rale 



A COMPARISON OF THE BIRTH RATES OF 

NATIVE AND OF FOREIGN-BORN 

WHITE WOMEN IN THE 

STATE OF NEW YORK 

DURING 1916 



P. R. EASTMAN 
Division of Vital Statistics 



HERMANN M. BIGGS, M.D. 
Commissioner 



New York State Department of Health 
Albany, N. Y. 



Issued by the 
Division of Public Health Education 



D. of $. 
JUN 24 1918 



<*>% 




.* 



°\ v 



A COMPARISON OF THE BIRTH RATES OF NATIVE AND 
OF FOREIGN-BORN WHITE WOMEN IN THE STATE 
OF NEW YORK DURING 1916 

P. R. Eastman 

Division of Vital Statistics 

The following matter is not intended as a scientific study of the relative 
fecundity of native and of foreign-born women. This will be immediately 
apparent to all students of the question. The first essential of a study 
of this nature would be a careful and accurate census of the population 
according to nativity, race, sex, age and marital condition, which, of 
course, is not available at the present time. Moreover, the long time 
which has elapsed since the 1910 census and the abnormal situation exist- 
ing since August, 1914, preclude reliable estimates of the population 
based on that census. 

The tables herein presented were compiled primarily as an aid to the 
officials of the New York State Department of Health in their efforts 
to improve birth registration, to control the practice of midwifery, and 
to reduce the infant mortality. In this regard they have practical value 
which seemingly warrants their publication. 

According to the annual reports of the Commissioner General of 
Immigration, approximately 28 per cent of all immigrant aliens entering 
this country in recent years have done so with the intention of settling 
in the State of New York. In the case of those coming from Southern 
Europe, Austria-Hungary and Russia the percentage is probably even 
higher. 

Bearing in mind the fact that these people are generally poor, illiterate, 
and ignorant of the first principles of sanitation, the effect which a large 
percentage of them in a community might have on the health of that 
community is readily conceivable. Particularly is this likely to be true 
in regard to the health of infants during their first year of life. Accord- 
ingly, as a first step in the direction of ascertaining just how great an 
effect, the existence of this element in the population has on infant 
mortality, a comparison of the birth rates of the native and foreign- 
born elements has been attempted in the tables following ; birth rates and 
birth registration bearing a most important relation to the subject. 

These tables all relate to New York State, excluding New York City. 
This is due to the fact that no certificates of births, deaths or marriages, 
either in original or copied form, are forwarded to the State Department 
of Health, the New York City Department of Health compiling and pub- 
lishing its own statistics and forwarding only monthly and annual 



reports to the State authorities. The data contained in these reports 
are usually in such form as not to permit their inclusion in the tabulations. 
Efforts have been made to make these tables as self-explanatory as 
possible; consequently no extended analysis is contemplated and atten- 
tion will be directed only to the most important features of each. 

The opinion has long been prevalent that the birth rate of foreign- 
born women is much greater than that of native women. Reliable data 
as to the exact difference, however, are very scarce and particularly so 
regarding the State of New York. 

Table I is an attempt to estimate the birth rates of the most important 
nationalities. 

Table I 
Births to White Mothers According to Nativity of Mother 



Nationality of Mother 



Total white 4 

Native white 3 

Foreign-born white 

English, Scotch and Welsh . 

Irish 

German (includes German 

Poles) 

Italian 

Russian (includes' Finland 

and Russian Poland) . . 
Austro-Hungarian (includes 

Austrian Poles) 

Canadian 

Other foreign-born 



Estimated 
popula- 
tion in 
1916 



643-786 
777-685 
866,101 

97.695 
124,467 

I7L435 
141.845 

82,195 

81,256 

104,270 
62,938 



Number 
of births 



'102,834 

64,889 

37.914 

1 , 869 

1-879 

2,421 
12,998 

7,281 

7.307 
2,219 
1,940 



Number 
of births 
per 1,000 
estimated 

popula- 
tion 



22. 1 
17.2 
43-8 

19. 1 

I5-I 

14. 1 
91 .6 



21.3 
308 



Crude birth 
rate of 
native 
country- 
according 
to last 
report 
before war 



f2 4 .I 

tt25-5 
22.8 



44.0 

U36.3 
§24.0 



Date 

of 

last 

report 

before 

the war 



1913 
1913 

1913 
1913 

1909 

1912 

1913 



* Nativity of mother unknown in the case of 31 births. 

t England and Wales, 
ft Scotland. 

X Austria. 
XX Hungary. 

§ Province of Ontario. 

This table shows the number of births per thousand total population 
of each of the principal nationalities living in New York State, according 
to the nativity of the mothers. 

The population estimates are based on the Federal Census of 1910 
and the New York State Census of 191 5, the total population for 1916 



being computed According to the rate of arithmetical increase between 
the two censuses. The proportions of the different nationalities are 
assumed to be the same as existed in 1910. 

From a strictly scientific standpoint these figures are not thoroughly 
reliable. For all practical purposes, however, there seems to be no adequate 
reason why they should not be used. If anything the birth rates of the 
foreign-born are probably too low, since it is likely that the percentage 
of each foreign nationality to the total population was not as great in 
-1916 as it was in 1910, owing to the practical cessation of all immigration 
during the years 1915 and 1916. This would probably more than offset 
any increase that may have occurred in the foreign population of the 
State from an influx of these people from other states, attracted "by 
better industrial conditions, etc. It may therefore, be assumed, that 
whatever error there may be, would, if corrected, but emphasize the 
point that the birth rate of native women in New York State is so low 
that it is undoubtedly as low, or lower, than that of France, and that 
the birth rate of the foreign-born woman is almost twice as great as that 
of the native woman. 

The above birth rates (17.2 for native women and 43.8 for foreign 
women) are not fairly comparable owing to the great difference 
between the age constitution of each element. There is not only a 
greater proportion of married women from 15 to 45 years of age among 
the foreign class (according to the 1910 U. S. Census it amounted to 
70 per cent as against 52 per cent for native women) but a larger per- 
centage of them are between the ages of 21 and 30, the period of greatest 
productivity. This is well illustrated by Table II. 

Table II 

A Comparison of the Crude, Legitimate and Illegitimate Birth Rates of 
Native and Foreign-born Mothers 







Birth Rates 






•\ 




Excess 




Births 


Births to 


percentage 




to native 


foreign 


of births 




born 


born 


to foreign 




mothers 


mothers 


born 


• 






mothers 


Number of births per 1,000 inhabitants 


17.2 


43-7 


154 


Number of legitimate births per 1,000 








married women 1 5-44 years of age 


I37-I 


253 -2 


85 


Number of illegitimate births per 1 ,000 single, 








widowed and divorced women, 15-44 years 








old 


2. 1 


3-2 


52 





After a perusal of this table it is clear that instead of the birth rate 
of the foreign woman being 154 per cent greater, as evidenced by the 
crude birth rates, it is in reality only 85 per cent greater when computed 
according to the number of married women of childbearing age. 

Before proceeding further it is interesting to compare the rates pre- 
vailing in the State of New York in 1916 with those estimated by Dr. 
R. R. Kuczynski in his well-known study of the birth rates of native and 
of foreign-born women in Massachusetts in 1895. 

Table HI 

A Comparison of the Birth Rates in Massachusetts in 1895 AND IN New York 

IN I916 



Massa- 
chusetts, 
1895 



New 

York, 

1916 



Births per 1 ,000 native population 

Births per 1 ,000 foreign-born population 

Births per native adult female population 

Births per foreign-born females 

Births per married native women of child-bearing age 
Births per married foreign-born women 



17.2 
43-7 



*io7 



t48.6 

fl04-2 



P I42 

"251 



1-1371 

t253 • 2 



* Ages 14-50. 
t Ages 15-44. 

The remarkable similarity in the above rates seems to prove that the 
amount of inaccuracy in the population estimates for New York State 
in 1916 is probably not very great, and that the} r are apparently quite 
trustworthy for all practical purposes. 

Reverting to Table I, the features of interest that at once attract the 
attention are the extraordinarily high rates of the Italians, Russians and 
Austro-Hungarians (which amount to from 100 per cent to almost 200 
per cent higher here than in the mother countries) and the exceptionally 
low rates of the Irish and the Germans. A study of the statistics of immi- 
gration as contained in the reports of the Commissioner General of 
Immigration of the United States will reveal the probable cause of these 
remarkable differences. Of the total number of Italians, Austro- 
Hungarians and Russians, who were admitted into this country since 
July 1, 1880, 75.3 per cent, 73.1 per cent and "jj per cent respectively, 
arrived here during the period from July 1, 1900 to June 30, 191 4, while 
of the total number of Germans admitted since 1880, 60 per cent arrived 
prior to June 30, 1890 and only 19.4 per cent since July 1, 1900. The 



exact data regarding the Irish were not obtainable from the records from 
which the above figures were extracted* but it is very probable that the 
percentages are more or less similar to those of the Germans, assuming 
that the difference of age upon arrival does not differ materially between 
the two nationalities. This means that the three nationalities in New 
York State first mentioned are mostly composed of young adults in the 
most productive period of life, while the Germans and Irish are mostly 
people past the childbearing age, or at least in the later stages of that 
period when the birth rate is much lower. It is notable that the 
Canadians and British have lower birth rates in New York than in their 
respective countries of birth. This may be due to the greater similarity 
of their age constitution to that of the native class and to their greater 
inclination and ability to adopt the American standard of living. 

Attention is directed to the fact that 73.1 per cent of all births to 
foreign-born women were to Italian, Russian and Austro-Hungarian 
mothers and that these races accounted for nearly 27 per cent of all the 
births occurring in the State outside of New York City, although they 
furnished less than 7 per cent of the total population. 

In view of the foregoing, it appears obvious that in order to compute 
the degree of completeness of the birth registration of a district, greater 
attention should be given to the constitution of the population and par- 
ticularly to the number of Italians, Russians, Austro-Hungarians and 
Poles residing in the district. A method more or less practiced, of 
settling on a certain standard rate, such as 25 births per thousand total 
population (which ma}' be said to be the average for most of the civilized 
nations) and assuming thereby that any community falling below that 
rate is deficient in birth registration, is likely to be very inaccurate and 
misleading. A community containing a large percentage of these peoples 
is bound to have a birth rate much in excess of 25 to the thousand popu- 
lation and a community comprised almost entirely of people of native 
birth is quite certain to have a birth rate of less than that figure. 

In order to test the truth of this assertion a glance at Table IV will be 
instructive. 

It will be noted that of those cities having a crude birth rate of less 
than the average (26), only two, Mt. Vernon and New Rochelle, had in 
1910 proportions of Italians, Russians and Austro-Hungarians greater 
than 6.8 per cent. On the other hand the lowest percentage of these 
people found in a city with a birth rate above the State average was 
7.6 per cent. The average percentage of Russians, Italians and Austro- 
Hungarians in the populations of the first named group of cities is 
6.3 per cent against 10.2 per cent for the latter group. 

* Commissioner General of Immigration's Report June 30, 1914 









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It is possible that in the cases of Mt. Vernon and New Rochelle there 
has been a considerable decrease in the proportions which these people 
form of the respective populations since 1910. Evidence of this fact 
seems supplied in the unusually low birth rates prevailing in each city 
among the women of foreign birth, who were 15 to 44 years old. 

Judging from a comparison of the exceptionally high birth rates of 
the foreign-born women, 15 to 44 years old, with the comparatively 
small number of Italians, etc., resident in 1910 in. the cities of Utica, 
Binghamton, Poughkeepsie and Auburn, it is probable that the propor- 
tion of these people has greatly increased in these cities since 1910 
through improved industrial conditions or from other causes. 

The rates in this column (births per 1,000 women 15 to 44 years of 
age) have been computed under the assumption that the same percentages 
of women of these ages existed in 1916 as in 1910. For reasons already- 
stated, however, they are not thoroughly reliable and must be taken with 
much reserve, as is quite apparent from the instances cited above. It is 
nevertheless interesting to note the generally low birth rates of the 
foreign-born women from 15 to 44 years of age, in those cities which 
shelter a small percentage of the people under discussion and the gener- 
ally high rates prevailing in those cities containing a large number of 
them. 

Special instances of the importance of carefully considering the com- 
position of the population before passing on the degree of completeness 
of its birth registration, are the four cities with the lowest crude birth 
rates, Albany, Troy, Newburgh and Kingston. These cities have long 
been considered to be greatly deficient in this regard, but it is quite evi- 
dent from the above table that while it may be true that there is con- 
siderable laxity in this direction in these cities, it is by no means the 
only reason for their low birth rates, the principal cause probably lying in 
the composition of their female populations. Each of these cities has 
few Italian, Russian or Austro-Hungarian residents; each has a small 
percentage of foreign-born females of child-bearing age; in each the 
number of married women is much below the average ; while the most 
numerous foreign races in each are those of low fertility, namely, Irish, 
British or German. 

The question that naturally arises from a study of the preceding tables 
is, " How does the foreign-born mother compare with the native mother 
in her ability to rear her children after they are brought into the world? " 
Some evidence regarding this question is furnished by Table V which 
purports to be a study of the 1916 living births according to the number 
of children born to and the number of children living to each mother at 
the time of and including the 1916 birth. 



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The outstanding feature of this table is the manner in which the native 
mother excels the mother of foreign birth in her ability to rear her 
children and the way in which this superiority increases proportionately 
to the number of children born to each. Although among mothers who 
had given birth to two children, the foreign-born mothers had lost only 
about one in a hundred children more than the native, among those who 
had borne thirteen, the foreign-born mothers had lost nearly eight in a 
hundred more than the native mothers. 

But as already mentioned, it must be remembered, that this tabulation 
refers to the number of children living at the moment of birth and no 
account is taken of those dying shortly afterward. Since the infant 
mortality amongst the foreign element is considerably higher than that 
for the native part of the population, very likely the above difference 
in percentage would be augmented if these deaths were taken into 
consideration. 

Another circumstance showing the better care that the native mother 
takes of her children is that 79 per cent of the American-born mothers 
had all their children living at the time of the 19 16 birth as compared 
with only 66 per cent of the foreign-born mothers. Altogether the alien 
mothers' loss exceeded that of the native mothers' by more than five in 
a hundred; but the greater mortality among children of the foreigner 
is most graphically shown in the fact that whereas three children died 
to every ten native mothers, six died to every ten foreign mothers. 

The foreign mother's ability to rear her children does not seem 
commensurate with her superior fecundity. When compared with the 
native mother this become especially apparent, and judging from the 
above table, the advantage of the native mother in this respect increases 
proportionately with the size of the family. 

As to the average number of children born to each mother, it appears 
that each mother of foreign nativity gives birth to about one more child 
than the American-born mother does, the exact figures being 3.78 for 
the former and 2.85 each for the latter. This, of course, only applies to 
the women who gave birth to children in 191 6. If a census of all the 
married women were taken, together with the number of their children, 
it would undoubtedly be shown that the average number of children per 
mother is considerably less than the above numbers, but especially so in 
the case of native women, since it is probable that a much larger pro- 
portion of them are childless.* 



* According to the report made by the Immigration Commission to the 6ist Congress, 2nd Session 
(Document No. 282) on the Fecundity of Immigrant Women, the percentage of childless native women 
who were under 45 years old and who had been married from 10 to 20 years in 1010, was 13.1% while 
that of women of foreign parentage was only 5.7%. 



Another fact of interest is that whereas 57.3 per cent of the births to 
native women were either the first or second child born fo them, only 
39.7 per cent of the births to foreign-born women were of this sequence. 
This may be partly accounted for by the probable greater average num- 
ber of years during which the women of foreign birth had been married, 
due to their custom of marrying at a much earlier age than do native 
women. 

It is rather surprising to note that there were 2,564 mothers to whom 
the 1916 birth represented at least the tenth child born, 1,150 of these 
mothers being natives, while 1,414 were aliens. 



Table VI 

Children Living with Native and Foreign-born White Mothers to Whom a 

Child Was Born in 19 16 



Number of Living Children in 
Family 



Native Mothers 



Number 



Per cent 
of total 



Foreign-born 

Mothers 



Number 



Per cent 
of total 



1 
2 
3 
4 
5 
6 

7 
8 

9 
10 
11 

12 
13 
14 
15 
16 



23,864 

16,378 

9-991 

5,816 

3.641 

2,188 

1.323 
792 

398 

254 
114 

59 
20 

5 
2 
2 



8,906 

8,550 

6,720 

5,002 

3,438 

2,303 

i>384 

760 

428 

208 

98 

4i 

15 

1 



23 -5 
22.6 
17.8 
13.2 

9-i 
6.1 

3-7 

2.0 

1 . 1 

•5 

•3 

. 1 



The chief value and interest of Table VI (showing the number of 
mothers according to the number of their living children) depends upon 
a comparison with the section of Table V, which shows the number 
of mothers according to the number of children born to them. 

The practice of midwifery and its proper control has come to be 
recognized in recent years by health officers as so important a matter 
that a certain amount of space may appropriately be given here to the 
subject. 



Table VII 



Births Attended by Midwives, According to the Nativity of the 

Mothers 



Nativity of Mother 



Total 
births 



Births Attended by 
Midwives 



Number 



Per cent 
of total 
births 



Native white 

Foreign-born, white 

England, Scotland, Wales 

Ireland 

Germany 

Italy 

Russia 

Austria-Hungary 

Poland (includes German, Austrian and Russian 

Poles) 

Canada 

Other foreign-born 



64,889 
37.9H 



2,504 
14-165 



3-9 



1,879 
2,296 
12,998 
3.665 
6,345 

4.703 
2,219 

1,940 



28 
29 

633 
5.276 
1. 174 
3.630 

3. 112 

44 

239 



i-5 

i-5 
27.6 
40.6 
32.0 
57-2 

66.1 

2.0 

12.3 



The first fact made evident by Table VII is that if it were not for the 
foreign-born part of the population, there would be no midwife problem. 
Less than 4 per cent of the births to native mothers were attended by 
midwives, while more than 37 per cent of the births to foreign-born 
women were, so attended. 

Here again the highest percentages are found among the Italians, 
Russians, Austro-Hungarians and Poles, although the Germans also 
employ a large number of these women in preference to physicians. 
In contrast to these, attention is directed to the exceptionally small 
number of confinements of British, Irish and Canadian mothers attended 
by midwives. Apparently they employ midwives even less frequently 
than do native women, but it seems likely that the majority of the mid- 
wives attendant on the latter were employed by women of native birth 
who were of Italian, Russian or Austro-Hungarian parentage and with 
whom the custom of the native country of their parents still held 
considerable sway. 

Table VIII is a tabulation of the 49 cities or villages, each having a 
population of 10,000 or more, arranged in order according to the extent 
to which midwifery is practiced in each and showing, at the same time, 
the relation of this practice to the number of German, Italian, Russian, 
Polish and Austro-Hungarian residents. The correlation of these two is 
so obvious that further commentary seems unnecessary. 



J 3 

Table VIII 

The Practice of Midwifery in the Cities and Villages of 10,000 or More 

Inhabitants 



City 



Total 
births 



Births Attended 
by Midwives 



Number 



Percentage 



Per cent of total 

population 

comprised by 

Germans. 
Italians, Poles, 
Russians and 

Austro- 
Hungarians 



Lackawanna 

North Tonawanda 

Amsterdam 

Dunkirk 

Port Chester 

Buffalo 

Rome 

Schenectady 

Utica -. . . 

Yonkers 

Mt. Vernon 

Binghamton 

Little Falls 

Poughkeepsie 

Auburn 

Watervliet 

Albany 

New Rochelle 

Cohoes 

Niagara Falls 

Ossining 

Troy 

Syracuse 

Hudson 

Rochester 

Newburgh 

Peekskill 

Saratoga Springs . . 

Olean 

Oswego 

Jamestown 

Watertown 

Rensselaer 

Elmira 

Ogdensburg 

Kingston 



812 
394 
993 
543 

504 

13,064 

706 

2,135 

2,441 

2,504 

891 

1,508 

455 
759 
854 
256 

2,283 
732 
57i 

i,437 

224 
i,336 
3,851 

356 

6,825 

533 
320 

257 

502 

572 
827 
685 

162 

983 
336 
469 



474 
178 

438 

235 

206 
,196 

275 
828 

911 
917 
313 

527 

145 

221 

217 

55 

466 

141 
107 

255 

38 
222 

587 
53 



66 
36 

27 

5i 

53 
88 

33 

5 

28 

6 

5 



43-6 
23-5 
26.3 
23.6 

23.2 
18.4 
14.0 

■17-3 

19.6 

20. 1 

16.9 

9.0 

23.0 

9-9 

11. 9 

6.4 

10. 1 

8.2 

8-5 
16.6 

14-5 
8.0 

13-4 

15-2 



15-9 
7-i 
9.2 

5-5 

9-2 

7-9 
4.2 

4-9 

3-4 
8.0 
1.8 



14 



Table VIII {continued) 

The Practice of Midwifery in the Cities and Villages of 10,000 or More 

Inhabitants {continued) 



City 



Total 
births 



Births Attended 
by Midwives 



Number 



Percentage 



Per cent of total 

population 

comprised by 

Germans, 
Italians, Poles, 
Russians and 

Austro- 
Hungarians 



Johnstown . 
Gloversville 
Cortland . . . 
Ithaca 

Corning .... 
Lockport . . . 
Middletown 
Glens Falls. 

Hornell 
Batavia .... 
Geneva .... 
Fulton 

Plattsburg . 



418 
269 
34i 

343 

357 
285 

303 

291 
337 

354 
296 

222 



In the final summary, therefore, it seems obvious that although the 
preceding tables relate to the single year of 191 6 only, there is no ques- 
tion but that the foreign element in the population of New York State 
affects the general birth rate in this State to an extraordinary degree. 

This particularly applies to the large number of Italians, Russians, 
Poles and Austro-Hungarians, the greater number of whom have settled 
in this country during the past fifteen years, having arrived here for the 
most part during early adult life, married at an early age and reared large 
families, the birth of each child following closely upon the preceding one. 
The majority of them are still in the most fertile period of life and 
very few of them are past the reproductive age. 

Furthermore, considering the general poverty among these people, 
their propensity to settle in the most crowded and densely populated 
districts of the large industrial and manufacturing centers, that many 
of the women help in earning the livelihood of the family through out- 
side work and that most of them are not only unable to read and write 
English, but also unable to speak it, being thereby incapable of under- 
standing and of following the sanitary regulations, etc., it is to be 



15 

"expected that their effect on the infant mortality of the State is also very 
considerable. 

The logical conclusion to be arrived at from a study of the foregoing 
data is therefore manifest. It is that in all future campaigns for the 
improvement of birth registration or for the conservation of child life, 
more careful consideration must be given to parental nativity. 

This should be determined beforehand in each community selected for 
study along these lines. It is the sine qua non of all real progress and 
efficiency attainable in this direction. 



